Reply to: KUATB Chumps

[vetran]

Do you think you are an average patient? You very much aren't. Neither am I, or pretty much anyone on CUK. My original point was, for many seeing a doctor in person is a hugely important thing. You saying "it's not a big deal for me" doesn't alter that.

It's fine to offer phone or video consultations and I'm sure many would prefer that. Very convenient. But this is very different from mandating it. And the evidence I've seen is that doctors aren't then calling people in if there's any doubt, they just give them their best guess over the phone and dish out some pills, when 5s in person would've made it very clear.

Choice is good. But it should be a choice.

Perversely supporting the wail's mandate for all face to face consultations seems at odds with your stance on remote appointments.

What we need to be as suggested extensively above is pragmatic and identify which appointments are better remote or face to face for each type of customer. At the same time we probably need to decide which resources to use. Many reports suggest doctors like most other public facing businesses have frequent flyers and could streamline or delegate the ones that don't need medical attention.

A well person clinic staffed with competent resources that can do triage and or have a single doctor as well like a walk in clinic will have a greater throughput for most common ailments.

[Paralytic]

Choice is good. But it should be a choice.

Are you proposing that should always be the patient's choice?

[d000hg]

Actually I and others have had Telephone consultations and they have been extremely effective.

Do you think you are an average patient? You very much aren't. Neither am I, or pretty much anyone on CUK. My original point was, for many seeing a doctor in person is a hugely important thing. You saying "it's not a big deal for me" doesn't alter that.

It's fine to offer phone or video consultations and I'm sure many would prefer that. Very convenient. But this is very different from mandating it. And the evidence I've seen is that doctors aren't then calling people in if there's any doubt, they just give them their best guess over the phone and dish out some pills, when 5s in person would've made it very clear.

Choice is good. But it should be a choice.

[vetran]

Sounds like a very sensible system. I've also always thought that maybe we should not train doctors on every issue, rather have shorter courses for specialists on specific health problems.

PS I'll pop in and see the local pharmacist on Monday about my nappy rash.

You need to charge NLyUK extra for that!

[xoggoth]

Sounds like a very sensible system. I've also always thought that maybe we should not train doctors on every issue, rather have shorter courses for specialists on specific health problems.

PS I'll pop in and see the local pharmacist on Monday about my nappy rash.

[vetran]

The welsh seem to be getting on with it

https://www.wales.nhs.uk/news/50454

“The Common Ailments Scheme is a very good one that takes some of the pressure off GPs and it will be even better when more people realise that it is available.

“The cost of medicines has also been a huge factor. People can get free prescriptions when they go to see a doctor, but have had to pay quite a lot for over-the-counter medicines at the pharmacy. Now, through this new scheme, they can get medicines free of charge from their pharmacy and I think that will make a big difference. “

The Common Ailments Scheme is available in all local 125 community pharmacies in the ABMU area – Swansea, Neath Port Talbot and Bridgend. You have to register with the pharmacy to use the scheme, but the process only takes a few minutes. Consultations are carried out in a private room and if the pharmacist decides you still need to see a doctor, they will refer you.

The 26 ailments covered by the Common Ailments Scheme are: acne, athlete’s foot, back pain, chickenpox, cold sores, colic, conjunctivitis, constipation, diarrhoea, dry eyes, dermatitis, haemorrhoids, hay fever, head lice, indigestion, ingrowing toenails, ringworm, mouth ulcers, nappy rash, oral thrush, scabies, sore throat/tonsillitis, teething, threadworms, vaginal thrush, and verrucae.

[vetran]

oh look something else that could go on the production line.

https://www.dailymail.co.uk/femail/a....html#comments

How to spot cancerous moles after the summer: Screening nurse reveals the 'ABCDE' test YOU can carry out at home - and the less obvious signs to look out for

• Screening nurse Laura Harker revealed the warning signs of melanomas
• New moles appearing in adulthood need to be monitored if growing or changing
• A key warning sign is when a mole stands out and looks different to other moles
• She says a common mistake is ignoring legions that look like a freckle or skin tag

[vetran]

If the NHS are short of test tubes then how can we do blood tests 7 days a week?

Also has it concerned you that someone needs to process and analysis the test results in a lab before they are sent to back to the GP/doctor? The people doing the analysis have more skills and qualifications than the people taking the tests.

BTW when I've been for health check ups they are either done by the practice nurse or a healthcare assistant. In fact none of the blood tests I've ever had at a GP practice have been taken by a GP it is either a nurse practitioner, nurse or healthcare assistant.

A short term shortage of test tubes doesn't negate the strategies validity. You know we could plan the project then create a secure supply line, maybe even make them in an automated factory in the UK? Maybe even have stock in warehouses?

No Something has to process and analyse the test results. Most blood tests are done by a machine nowadays. The results can also be done by a machine. so interview 10,000 people using a script developed by world experts by phone or internet, mark those with suspicious symptoms (marked automatically) test that 1000 people, if 500 people have evidence of disease then channel them to medical professionals.

We are processing 400,000 covid tests a day that isn't a load of highly trained people bending over microscopes it is thousands of medical students (if we are lucky) on near minimum wage loading machines that beep and spit out a text with a result.


Have a look at the Galleri trial:

https://digital.nhs.uk/services/nhs-...-galleri-trial

Its a bit pricey at $950 a pop but we could develop something similar much more cheaply in the UK that didn't just do Cancer.

Again automation of X-Ray analysis is a thing and because they could roll up the expertise of world experts and create a tool that is always at its best it can replace many experts or better augment them by automatically highlighting areas of concern.

Yes many blood takings are done by Nursing staff either in the Hospital where they have a fairly organised system with multiple nurses doing patients in a couple of minutes or so or by a nurse in a practice who could be doing better things. Transfer that to a mobile unit so sick people don't have to go to hospitals and it can be done for longer hours an days as you say by healthcare assistants with one supervising nurse for 5- 10 assistants. Leaving the nursing staff to do more useful things.

To ask the right questions for say 60-80% of ailments we don't need doctors. In most cases, to identify the worrying answers again we don't need doctors, to do the tests again we don't need doctors. To share the results and create a treatment plan we will need lots of doctors which we don't have but at least we will be using the ones we have much better.

If we set this up nationally we can benefit from the infrastructure that we steadily improve for centuries.

We have 111 on phone & web it isn't actually isn't terrible (it could obviously be much better ) but moving filtering, diagnosis and testing for many long term ailments away from the GP surgeries will decrease our reliance on the bottleneck of shortage of medical experts.


Have a look at the backlog and consider how aggressive testing could slash waiting times.

https://www.bma.org.uk/advice-and-su...nts-in-the-nhs

For instance for a cancer or heart situations the first thing that the consultant will ask for are tests. If we do those before visiting the consultant then waiting times are slashed, a Nurse or counsellor can deliver the results and get you on to a documented treatment plan based on advice from oncology. Leaving the consultants time to work on the really difficult cases or strategy.

https://www.nhs.uk/conditions/nhs-screening/

[SueEllen]

You may know that many local hospitals have a month plus waiting list for blood tests which delays diagnosis further. We are also short of the test tubes used. I'm suggesting doing tests 7 days a week 16 hours a day in mobile sites. We have built massive testing resources for covid just expand them or turn them into testing other things.

If the NHS are short of test tubes then how can we do blood tests 7 days a week?

Also has it concerned you that someone needs to process and analysis the test results in a lab before they are sent to back to the GP/doctor? The people doing the analysis have more skills and qualifications than the people taking the tests.

BTW when I've been for health check ups they are either done by the practice nurse or a healthcare assistant. In fact none of the blood tests I've ever had at a GP practice have been taken by a GP it is either a nurse practitioner, nurse or healthcare assistant.

[vetran]

While GPs can do blood tests in my wider area, you get them done much quicker and you can have them done 5 days per week if you book an appointment in a local clinic/outpatients at a hospital.

Its funny you really aren't understanding my point.

We are currently facing a massive backlog. My experience in such a situation is to divide and batch tasks as efficiently as possible. Some things can only be done by X experts (e.g. GPs) but the majority of things can be done by less trained individuals following a script or even a bot.

By streaming demands and concentrating resources you can massively increase throughput and quality.

We know the bottle necks are the current organisation so identify the majority of simple cases and ramp up temporary or even permanent support for these. So if 20% of cases require a mammogram or sonogram and 20% need blood tests funnel users that will probably need these (via online consults/questionnaires) then make it happen.

So a quick questionnaire, EKG, blood pressure test, blood sugar test and blood taking for tests at a mobile site will probably be sufficiently enlightening that a basic diagnostic screen for heart disease, many cancers , diabetes etc can be done without disturbing a GP, just send them and the relevant experts the report clearly marked and they can review it in seconds.

Allegedly missing a 15 minute appointment with a doctor costs £120 that is an awful lots of tests and questionnaires done by health care assistants in the same time.

You may know that many local hospitals have a month plus waiting list for blood tests which delays diagnosis further. We are also short of the test tubes used. I'm suggesting doing tests 7 days a week 16 hours a day in mobile sites. We have built massive testing resources for covid just expand them or turn them into testing other things.

If we set up a national screening program that is cheap and efficient think how many lives we can save. How much we can sell the skills to other countries for.

[xoggoth]

I'm not saying the MAC should not be taken seriously, I'm saying that the Wail chooses to headline stories that appeal to its believers, while paying less attention to others that might challenge them.

So what newspaper doesn't do that?

Slightly off topic but one things I've noticed recently is that more and more people prefer to comment on articles in online newspapers that they don't agree with.

[SueEllen]

I would be quite happy to book a blood test in the supermarket as long as confidentiality is assured.

While GPs can do blood tests in my wider area, you get them done much quicker and you can have them done 5 days per week if you book an appointment in a local clinic/outpatients at a hospital.

[vetran]

They managed to do virtually all consultations in person pre-CV. For many people the face-to-face nature is incredibly important, your doctor is there to provide a steady voice as well as dish out pills, etc.

Actually I and others have had Telephone consultations and they have been extremely effective. If you have a long term condition that has a known direction you just need to observe progress its just as easy to talk to the doctor for five minutes and get the help you need. If they have any suspicion you need more they can either direct you to experts or get you in for a face to face. They can also be delegated.

The current receptionist triage is unacceptable!

We can change the way the NHS interface with patients. We can do almost all routine health checks in better ways.

For instance if you are receiving oral / IUD contraception like probably 20-30% of the population a Pharmacist or Health care assistant (in a pop up clinic) can check blood pressure, weight and fill in a general review:

https://www.linksmedicalpractice.co.uk/pill-checklist

The person's medical history can be done via existing health records and compared with the answers submitted electronically. Any red flagged reviews get called by an expert nurse.

Why have 6 - 12 years training to take blood pressure, weigh you and check medical records?

You can have pop up screening in Tesco's car park/store that at risk patients can be signposted to. One local Tesco has mammograms done in a trailer in the car park, a pop up blood tests, skin cancer checks (take a picture and send it for evaluation) & sonograms in a similar way. We do blood donations in churches why not a pop up clinic staffed with multiple assistants, nurses & 1 doctor? Large companies do blood donation in their car parks again a chance to reach people that don't have time to visit the doctor. School visits etc.

I would be quite happy to book a blood test in the supermarket as long as confidentiality is assured.

You can do more with Telephone consultations. Each call can take 2-5 minutes against 15+ minutes face to face. So 2-3 times as many appointments.

If their regulars need a chat & a cuppa then lets use volunteers (plenty of great people volunteer) or less expensive staff to do that. They can complete a review for each encounter and the reviews can be rolled up so only red flagged sessions are referred to a doctor.

[vetran]

Stating it doesn't make it true, or widely agreed. I don't know (m)any people who think the education system has improved in recent years (decades?) in fact most seem to think it's worse.




Those need to be worked out but the fundamental question is: should we identify and intervene under-performing surgeries? If not, it doesn't matter what definitions we use.

I would suggest we should have checks and measures in place to ensure people have good service on something as important as health, that doesn't vary massively based on which surgery they sign up to. I think some independent body should be responsible for detecting and responding to issues whether it's a single GP or a surgery /medical practice. I think the 'customers' should be able to easily provide feedback that feeds into that process.
I don't think we should have some sort of "GP TripAdvisor" where you can see public reviews shaming individual doctors.

I was under the impression a lot of this stuff was supposed to already exist though.

No but reputable studies suggest it is true.



https://www.independent.co.uk/news/e...-a9230711.html

https://www.usnews.com/news/best-cou...-for-education

Strangely worldwide stats are available.

https://gpseducation.oecd.org/Countr...ld=10&topic=EO


As I said above local schools that were so bad for decades before ofsted that they had to trawl the dregs for students are now massively over subscribed.

Now I agree grade inflation is worrying but overall education is demonstrably better at least in my area and the minds of international experts such as OECD & PISA.

There is no doubt we should measure the health system as a whole.

Stating it doesn't make it true, or widely agreed. There are a number of inspections that have proved 1 in 6 GP businesses are wildly underperforming.

https://www.theguardian.com/society/...ents-poor-care

One in six GP surgeries in England is at risk of offering patients poor care, including trouble getting an appointment and being given out of date medicine, the NHS care watchdog has warned.

About 1,200 practices potentially put patients either at “risk” or “elevated risk” through inadequate care, according to the Care Quality Commission (CQC).

In its first assessment of all 7,661 GP surgeries in England, the regulator warned that while many are looking after patients well, 1,200 (16%) pose such a concern that they will be visited and assessed under its tough new inspection in the next few months.

If you can't measure it you can't improve it. Being in BI I tend to see that on a daily basis. The minute you add decent reporting then you see obvious process improvements . I have seen millions saved at a stroke based on reports I and others wrote.

Extending the inspections and grading to include other important KPIs is a good idea in my opinion.

I am suggesting something similar to Ofsted inspections ( as above done but not regular) & grading (not as well done as Ofsted) not Tripadvisor. Strangely so are the government. The public feedback goes to Ofsted, they then decide whether to investigate. The stats are aligned, reported and procedures and direction are formulated centrally.

[d000hg]

Once the Mail wins its campaign for GP's to have to face to face consultations so forcing GP's to waste 80% of their time listening to trivial ailments, they will be able to get outraged at the ensuing waste of resources, and the cycle will continue.

They managed to do virtually all consultations in person pre-CV. For many people the face-to-face nature is incredibly important, your doctor is there to provide a steady voice as well as dish out pills, etc.